Population Of Depressed Patients Research Articles

Passiflora incarnata L., herba, in benzodiazepine tapering: long-term safety and efficacy in a real-world setting.

Chronic and inappropriate benzodiazepine (BDZ) prescription and intake represent an important health and social concern worldwide. The aim of our study was to investigate the safety and efficacy of P. incarnata L., herba in reducing BDZ misuse in a real-world population of depressed and anxious patients in a long-term treatment with BDZs. Over an 18-month period (from July 2021 to December 2022), we previously conducted a retrospective and naturalistic study on euthymic outpatients with a diagnosis of anxiety or depression and chronically taking BDZs. In this study we contacted patients 12 months after their enrollment in the previous study to assess their disease status and their BDZs and P. incarnata intake. Our findings support the effectiveness of a dry extract of P. incarnata L., herba, as an add-on treatment during BDZ tapering in patients with anxiety or depression. We confirmed this effect to be sustained over time, and P. incarnata showed to be easily discontinued with no rebound, withdrawal or psychological dependence effect. The absence of side effects and adverse events confirmed the safety of P. incarnata in a real-world population. Personality disorders confirmed to be a relevant risk factor for maintaining addictive behavior, even when symptoms associated to withdrawal seem to be not particularly relevant. We confirmed the possible effectiveness of P. incarnata as an add-on treatment in BDZ reduction. Further studies may be helpful to better investigate the promising properties of P. incarnata in the management of relevant clinical issues, such as anxiety disorders and addiction, that are classically known to benefit from GABAergic treatments.

Add-On Treatment with Passiflora incarnata L., herba, during Benzodiazepine Tapering in Patients with Depression and Anxiety: A Real-World Study.

Chronic and inappropriate benzodiazepine intake represents an important health and social concern worldwide. The aim of our study was to investigate the effectiveness of P. incarnata L., herba, in reducing benzodiazepine misuse in a real-world population of depressed and anxious patients in a long-term treatment with benzodiazepines. We conducted a retrospective naturalistic study on 186 patients undergoing benzodiazepine downtitration, 93 with the addition of a dry extract of P. incarnata L., herba (Group A), and 93 without any add-on treatment (Group B). Regarding the benzodiazepine dosage variation in the two groups, a repeated measure ANOVA showed a significant effect of time (p < 0.001), group (p = 0.018), and time x group interaction (p = 0.011). We found a significantly higher rate, i.e., of 50%, reduction in Group A vs. Group B at 1 month (p < 0.001) and at 3 months (p < 0.001) and complete benzodiazepine discontinuation at 1 month (p = 0.002) and at 3 months (p = 0.016). Our findings suggest the role of P. incarnata as an effective add-on treatment during benzodiazepine tapering. These findings highlight the need for further studies to better investigate the promising properties of P. incarnata in the management of such a relevant clinical and social issue.

P.327 Efficacy and safety of AXS-05, an oral, NMDA receptor antagonist with multimodal activity in major depressive disorder

The response to placebo is robust in studies of various antidepressant treatments. The strong placebo response, combined with the absence of side-effects, has prompted suggestions to use the ethically sound open-label placebo (OLP) as a treatment for depression. The aim of the present study was to assess the efficacy of OLP as an adjunct to treatment as usual (TAU) in the setting of a randomized controlled trial for the treatment of unipolar depression.Thirty-eight patients (age: 50 ± 17.1; 73.7% females) were randomized to either eight-week OLP treatment (n = 18) or four weeks of TAU followed by four weeks of OLP (n = 20). Clinical and socio-demographic measures were assessed at baseline, after four weeks, and at the end of the trial. Response to treatment was determined using the QIDS SR-16.There was an overall decrease in depression levels over time, F(2,35) = 3.98, p = .028. A significant group x time interaction was found only among non-geriatric patients (<65years) with an early onset of depression (<50years), F(2,22) = 3.89, p = .036. Post-hoc tests indicated a significant decrease during the first four weeks, but only in the OLP group, t(11) = 2.29, p = .043.Small sample size and the use of a self-report questionnaire to assess depressive symptoms.Our findings support the possibility that OLP is an effective treatment for the relatively young population of depressed patients. Additional studies are warranted to explore the use of OLP in clinical practice.

Open-Label placebo for the treatment of unipolar depression: Results from a randomized controlled trial.

BackgroundThe response to placebo is robust in studies of various antidepressant treatments. The strong placebo response, combined with the absence of side-effects, has prompted suggestions to use the ethically sound open-label placebo (OLP) as a treatment for depression. The aim of the present study was to assess the efficacy of OLP as an adjunct to treatment as usual (TAU) in the setting of a randomized controlled trial for the treatment of unipolar depression. MethodsThirty-eight patients (age: 50 ± 17.1; 73.7% females) were randomized to either eight-week OLP treatment (n = 18) or four weeks of TAU followed by four weeks of OLP (n = 20). Clinical and socio-demographic measures were assessed at baseline, after four weeks, and at the end of the trial. Response to treatment was determined using the QIDS SR-16. ResultsThere was an overall decrease in depression levels over time, F(2,35) = 3.98, p = .028. A significant group x time interaction was found only among non-geriatric patients (<65years) with an early onset of depression (<50years), F(2,22) = 3.89, p = .036. Post-hoc tests indicated a significant decrease during the first four weeks, but only in the OLP group, t(11) = 2.29, p = .043. LimitationsSmall sample size and the use of a self-report questionnaire to assess depressive symptoms. ConclusionsOur findings support the possibility that OLP is an effective treatment for the relatively young population of depressed patients. Additional studies are warranted to explore the use of OLP in clinical practice.

Clinical characteristics associated with the discrepancy between subjective and objective cognitive impairment in depression.

Patients with unipolar disorder (UD) commonly experience cognitive dysfunction during symptomatic and remitted phases. However, it is not necessarily the patients with the greatest subjective complaints, who display the largest objectively-measured deficits on neuropsychological tests. This report investigated the demographic and clinical factors associated withthe discrepancy between subjective and objective measures of cognition in two separate depressed patient populations in Denmark and New Zealand, respectively, using a new methodology. Data from 137 depressed patients and 103 healthy controls including neuropsychological test scores, self-reported cognitive difficulties, and ratings of mood were pooled from two studies conducted in Copenhagen, Denmark, and Christchurch, New Zealand, respectively. Cognitive discrepancy scores were calculated using a novel methodology, with positive values indicating disproportionately more subjective than objective difficulties (i.e., "sensitivity") and negative values indicating more objective than subjective impairments (i.e., "stoicism"). In the Danish partially remitted patient sample, greater 'sensitivity' was associated with more subsyndromal depression severity (standardized Beta (std. β )= 0.4, p < 0.01)), illness duration (std. β = 0.4, p < 0.01), and younger age (std. β = 0.6, p < 0.001). This association was replicated in the New Zealand sample of more symptomatic patients (p-values ≤ 0.05). The cross-sectional design hampered causal inferences. We had obtained different measures of objective and subjective cognition from the two studies. Patients with more depressive symptoms and younger age overreportedcognitive impairments across all illness states. The use of an objective cognition screener thus seems particularly relevant for these patients to assess whether subjective complaints are accompanied by measurable cognitive deficits.

The Techniques for Overcoming Depression Questionnaire: Mokken Scale Analysis, Reliability, and Concurrent Validity in Depressed Cardiac Patients.

The Techniques for Overcoming Depression (TOD) questionnaire assesses the frequency with which patients being treated for depression use cognitive-behavioral techniques in daily life. This study examined its latent structure, reliability and concurrent validity in depressed cardiac patients. The TOD was administered at the initial and final treatment sessions in three trials of cognitive behavior therapy (CBT) (n = 260) for depression in cardiac patients. Mokken scaling was used to determine its dimensionality. The TOD is unidimensional in depressed cardiac patients, both at the initial evaluation (H = .46) and the end of treatment (H = .47). It is sensitive to change and the total score correlates with therapist ratings of the patient's socialization to CBT (r=.40, p<.05), homework adherence (r=0.36, p<0.05), and use of cognitive-behavioral techniques (r=.51, p<.01). TOD scores were associated with post-treatment depression scores in two of the trials (p<.01 in both analyses). The TOD is a unidimensional, reliable, valid, and clinically informative measure of self-reported use of cognitive-behavioral techniques for overcoming depression in cardiac patients. Studies of the TOD in other depressed patient populations are needed.

Use of Selective Serotonin Reuptake Inhibitors and Sleep Quality: A Population-Based Study.

Poor sleep is a risk factor for the development and recurrence of depression. Selective serotonin reuptake inhibitor (SSRI) use is consistently associated with good subjective sleep in clinically depressed patient populations. However, studies in the general population are lacking. Our objective was to investigate the association between SSRIs and subjective sleep in a middle-aged and elderly population in a daily practice setting. We included participants from the prospective Rotterdam Study cohort. Participants had up to two subjective sleep measurements assessed with Pittsburgh Sleep Quality Index ([PSQI], number of measurements = 14,770). SSRI use was based on pharmacy records. We assessed the association between SSRIs and PSQI score and its sub-components, with nonusers of any antidepressant as reference. Analyses were, among others, adjusted for presence of depressive symptoms and concurrent psycholeptic drug use. We included 9,267 participants, average baseline age 66.3 y (standard deviation 10.6), and 57.6% women. SSRI use was significantly associated with a 0.78-point lower PSQI score (95% confidence interval [CI] -1.11; -0.44) which reflects better sleep, compared with non-use. The association was more prominent in continuous SSRI users (-0.71 points, 95% CI -1.18; -0.24). Of the sub-components, SSRIs were associated with 0.70-h longer sleep duration (95% CI 0.56; 0.85), higher sleep quality, higher sleep efficiency, and in contrast more daytime dysfunction. SSRI use was associated with better subjective sleep, after adjustment for depressive symptoms and concurrent psycholeptic drug use. This suggests that, in clinical practice in the middle-aged and elderly population, the sleep quality of some persons may benefit from, continued, SSRI use.

Why extra caution is needed in the case of depressed patients

It is disputed whether ‘depression’ refers to a set of closely related psychiatric illnesses characterised by a similar aetiology, or only to a family of symptoms, resulting from very different...

Psychometric properties of the Turkish version of the Leahy Emotional Schema Scale-II

Objective: The emotional schema theory (EST) reflects two styles of coping with emotions, i.e. normalizing, or pathological. These emotional schemas may be evaluated by the Leahy Emotional Schemas Scale (LESS). To ease the application of the LESS, a shortened version of it was introduced in 2012. Nevertheless, the psychometric properties of this new version has not been published so far. This study aims to evaluate the psychometric properties of the LESS-II in a sample consisting of clinically depressed outpatients and healthy controls. Methods: A total of 457 participants were recruited for this study. Only patients diagnosed with major depressive disorder, or participants with no axis I disorder were eligible to take part in the study. The participants completed the LESS, the Metacognitions Questionnaire-30, the Beliefs about Emotions Scale and the interviewer used the Montgomery Asberg Depression Rating Scale to determine the severity of the depression. Results: This study has shown that the LESS-II has good internal consistency, is a reliable and valid tool to assess emotional schemas in a clinically depressed patient population, has strong and significant correlations with the LESS, and to a great extent, is able to differentiate between clinically depressed patients and healthy controls. Discussion: The LESS-II has been shown to be a reliable and valid tool for the assessment of emotional schemas in a Turkish clinical population, and the findings provide further support for the evidence base of the clinical application of the EST.

Antidepressant drug development: Focus on triple monoamine reuptake inhibition.

Many patients with major depressive disorder (MDD) only partially respond, and some have no clinically meaningful response, to current widely used antidepressant drugs. Due to the purported role of dopamine in the pathophysiology of depression, triple-reuptake inhibitors (TRIs) that simultaneously inhibit serotonin (5-HT), norepinephrine (NE) and dopamine reuptake could be a useful addition to the armamentarium of treatments for MDD. A TRI should more effectively activate mesolimbic dopamine-related reward-networks, restore positive mood and reduce potent 5-HT reuptake blockade associated "hypodopaminergic" adverse effects of decreased libido, weight gain and "blunting" of emotions. On the other hand, dopaminergic effects raise concern over abuse liability and TRIs may have many of the cardiovascular effects associated with NET inhibition. Several clinical development programs for potential TRI antidepressants have failed to demonstrate significantly greater efficacy than placebo or standard of care. Successful late-stage clinical development of a TRI is more likely if experimental research studies in the target population of depressed patients have demonstrated target engagement that differentially and dose-dependently improves assessments of reward-network dysfunction relative to existing antidepressants. TRI treatment could be individualized on the basis of predictive markers such as the burden of decreased positive mood symptoms and/or neuroimaging evidence of reward network dysfunction. This review focuses on how the next generation of monoamine-based treatments could be efficiently developed to address unmet medical need in MDD.

Adding Low-Field Magnetic Stimulation to Noninvasive Electromagnetic Neuromodulatory Therapies

Adding Low-Field Magnetic Stimulation to Noninvasive Electromagnetic Neuromodulatory Therapies

The one-carbon-cycle and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in recurrent major depressive disorder; influence of antidepressant use and depressive state?

BackgroundAn important biological factor suggested in the pathophysiology of (recurrent) Major Depressive Disorder (MDD) concerns a polymorphism in a gene encoding for the MTHFR-enzyme of the one-carbon (1-C)-metabolism. Integratively investigating key 1-C-components (folate, homocysteine, vitamin B6 and B12), including the possible effects of antidepressant medication and depressive state, could provide more insight in the possible association between the MTHFR-polymorphism and recurrent MDD. MethodsWe compared the MTHFR C677T-polymorphism together with the key 1-C-components in clinically ascertained patients with recurrent MDD (n=137) to age- and gender-matched healthy controls (n=73). ResultsFirst, patients had lower folate (t=2.25; p=.025) as compared to controls; a difference that resolved after correction for demographics (t=1.22; p=.223). Second, patients that were depressed during sampling had lower vitamin B6 (t=−2.070; p=.038) and higher homocysteine (t=2.404; p=.016) compared to those in remission. Finally, current use of antidepressants had no influence on the 1-C-components. ConclusionsDespite investigation of a specific recurrently depressed patient population, we found no clear associations with the 1-C-cycle, except for higher homocysteine and lower vitamin B6 during the depressed state. This suggests that 1-C-cycle alterations in MDD are state-associated, possibly resulting from high levels of acute (psychological) stress, and may provide a treatment target to reduce cardiovascular risk in this population.

P 255. Transcranial direct current stimulation (tDCS) for the treatment of major depression: A pooled analysis from the Italian tDCS collaborative group

Introduction Transcranial direct current stimulation (tDCS) is a non-invasive and safe technique for the focal modulation of cortical brain areas, with an emerging role for treating major depression (Dell’Osso et al., 2011; Brunoni et al., 2012). Objectives The present study was aimed to analyze previous data from 141 patients, recruited from different Italian Psychiatric Clinics located in three geographically distinct areas: Milan, Verona and Naples. Such geographical heterogeneity makes it possible to consider the sample reasonably representative of the whole Italian population of depressed patients. Materials and methods 57 men and 84 women aged from 22 to 81 (mean 52.7) with current diagnosis of major depressive episode were considered for the pooled analysis. Comorbid conditions in Axis I, II and III were allowed, even though depression had to be the main issue at the moment of the admission visit. HAM-D (21 items) was administered as primary outcome measure, before and after tDCS, to assess treatment response. All patients underwent 10 bi-frontal applications of tDCS (anode in F3/cathode in F4, according to the 10/20 International EEG system); other stimulation parameters slightly differed depending on the study centers: 21 patients received daily 20 min applications of 1.5 mA current; 117 patients received twice-a-day 20 min applications of 2 mA current; 3 patients received daily 30 min applications of 2 mA current. Results A significant reduction of the HAM-D-21 total scores following tDCS (23.1 ± 7.2 pre vs. 17.7 ± 8.3 post, p p A repeated measures ANOVA using time as within factor and treatment as between factor revealed no significant differences in the main effect of treatment and in the time × treatment effects, meaning that the different treatment parameters did not influence the overall effect. Conclusion Our pooled analysis confirms the efficacy of bi-frontal tDCS for the treatment of Major Depression in the largest italian sample analyzed so far.

1311 – Response trajectories during antidepressant treatment of major mood disorder

A recent study by Levine and Leucht described several kinetics of treatment response among schizophrenic patients with antipsychotics. We aimed so to test this methodology in a population of depressed patients. 2938 outpatients with major depressive disorder were included in a multicentre, non interventional study, assessing at inclusion, week 2 and week 6, mood (QIDS-C, CGI, PGI and VAS) and functionality (SDS). To identify homogeneous groups of patients on the evolution of QIDS criteria over time (D0, W2 and W6), the latent class linear mixed model was used. Then, the groups were described at each time by several clinical characteristics and scores using ANOVA or the chi-square test. All metrics at day 0 and week 2 were tested for their capacity to predict a kinetic of response, all patients being treated by Agomelatine. 1200 patients were drug naïve for the current episode; 3 types of response kinetics were found: early, intermediate et late responders. The principal factor in relationship with a later response was the number of past episodes. Among the 1700 patients with a previous antidepressant treatment, 6 types of kinetics were distinguished: early response kinetics, intermediate and late response, non response and a singular one with early response at W2 and relapse at W6. The principal factor in relationship with a bad response kinetic was the age at first episode of mood disorder. Previous reports stressing the interest of an assessment at week 2 were reinforced by the present results.

Résultats de la cohorte française de l’étude observationnelle européenne FINDER : qualité de vie de patients traités par antidépresseurs

To describe health-related quality of life (HRQoL), pain, clinical outcomes and treatment patterns in French patients with depression treated by general practitioners and psychiatrists. Factors Influencing Depression Endpoints Research (FINDER) is a European longitudinal observational, naturalistic, multicentre study to determine the HRQoL (SF-36 and EQ-5D) and to assess outcomes of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), and pain (VAS) in a population of depressed patients initiating antidepressant treatment. Clinical diagnosis of depression was based on physician's clinical judgment. Physicians decided at their own discretion and clinical practice to initiate pharmacological treatment for depression. Adult patients with a first or new episode of depression were enrolled between May 2004 and September 2005, and followed up for 6 months. Across Europe, 437 physicians observed 3468 patients. In France, 606 patients (approximately 17% of the whole sample) were enrolled by 57 psychiatrists and 46 general practitioners. These patients were (mean ± SD) 45.6 ± 13.0 years old, 69% female and 39% having had a previous depressive episode in the last 2 years. According to the patient-rated HADS score greater or equal to 11, most patients (75%) were classified as cases of depression as well as cases of anxiety (84%); 51% of patients rated their overall pain severity (based on VAS cut-off of 30 mm) as moderate/severe, with 65% of these patients reporting no medical explanation for their pain. The majority (81%) of the patients were prescribed selective serotonin reuptake inhibitors (SSRI). During the 6-month follow-up, the majority of the patients (73%) remained on the same antidepressant at the same dose during the course of treatment. Between baseline and 6-month endpoint, French patients improved their mean scores (SD) on the SF-36 physical score by+3.5 (9.0) (P<0.001) and mental score by+20.6 (14.2) (P<0.001); on the EQ-5D Health State Index by+0.37 (0.32) (P<0.001) and the EQ-5D VAS by+32.3 (25.0) (P<0.001); on the HADS depression score by-8.1 (6.0) (P<0.001) and HADS anxiety score by-6.9 (5.0) (P<0.001). Patients with moderate/severe pain at baseline improved their overall pain on a mean VAS score by-34.1 (28.7) (P<0.001). More than half of the French patients enrolled in the study experienced pain associated with depression. During follow-up, patients improved all of their outcome measurements (physical and mental SF-36 scores, depression and anxiety HADS scores, pain VAS, EQ-5D Health State Index and VAS) and most patients remained on the same antidepressant at the same dose.

Dr Stübner and Colleagues Reply

Article AbstractLetter to the EditorBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.We would like to thank Dr Baldessarini for his comments on our article.Dr Baldessarini stated that in our sample of 142,000 patients undergoing treatment with antidepressant drugs, the rate of suicidal behavior is far lower than would be expected in a clinical population of depressed patients and that it is even lower than in the general population. This discrepancy is a consequence of the method applied.

Investigation Of Early Suicide-Related Symptoms In A Non-Suicidal Depressed Patient Population After Escitalopram Administration: A Pilot Study

Background: The efficacy of selective serotonin reuptake inhibitors (SSRIs) is well established in the treatment of major depression. However, an important delay in the onset of global action relative to placebo is described within the first weeks after their administration. Little is known about the experience over time on specific and suicide-related symptoms. Aims: This study aimed at investigating the experience over time of escitalopram on depression-related symptoms that are also associated with increased risk for suicidal behaviour. Methods: In an 8-week prospective uncontrolled open-label design, escitalopram was administered to 18 patients with a current major depressive episode. Mood, state anxiety, state anger and hopelessness were assessed at baseline and after 2, 4 and 8 weeks of treatment with escitalopram in a flexible dose regimen up to 20 mg. Results: Mood (p < 0.001), state anxiety (p = 0.002), state anger (p = 0.002) and hopelessness (p = 0.002) significantly improved after 8 weeks of treatment with escitalopram. However, symptom improvement varied over time. Mood and anger significantly improved after 2 weeks of treatment, whereas significant reductions of state anxiety and hopelessness were noticed only by the end of the study.Conclusions: This study underlines the early beneficial experience of treatment with escitalopram on mood and different suicide-related symptoms in a non-suicidal depressed patient group.

Tolerability and safety of duloxetine in a population of depressed patients with painful physical symptoms: results of a 6-month naturalistic study

Purpose: Safety of duloxetine (DLX) in depressed patients (pts) was observed in routine clinical care. Methods: Multicenter, prospective, 6-month observational study in adult outpatients with a depressive episode (ICD-10) starting DLX treatment, with solicited treatment emergent adverse events (TEAEs) reporting by general question. Results: Of 4,517 pts enrolled at 693 centers in Germany (mean age 52.2yrs, 71.8% fe-male), 4,313 could be included for TEAEs evaluation. 45.2% of the pts had concomitant psychiatric and 72.1% concomitant somatic diseases, and moderate to severe overall pain (VAS >30mm) was reported by 80.0% of pts. Concomitant pain medication was taken by 32.3% (permanent at BL) and 60.9% (on demand last 12 mth) pts. 1404 pts discontinued within 6 months (TEAEs: 119; other reasons: 415; no information: 870). 72.9% of pts started DLX with 30mg/d. At 4 wks 83.2% of pts were treated with ≥60mg/d. TEAEs occurred in 741 pts (17.2%). Related TEAEs (≥1%) included nausea, hyperhidrosis, vertigo, restlessness, sleep disorder and dry mouth. Serious TEAEs were reported by 34 pts (0.8%), including one case of suicidal ideation. Hospitalization for depression occurred in 132 (3.1%) pts. No relevant change in mean weight was observed from BL (77.1±15.6kg) to 6 mths (76.9±14.8kg). Conclusions: The TEAEs reported during DLX treatment in routine clinical use in a de-pressed patient population – with concomitant pain in the majority – were similar to previous studies. This study was supported by Lilly Deutschland GmbH, Bad Homburg, and Boehringer Ingelheim, Germany.

S40-01 New developments in diagnosis and therapy of depression in cardiovascular disease

Introduction:Repeatedly, it has been demonstrated that depression increases the risk of developing cardiovascular disorders; vice versa, in subjects with pre-existing heart disease, comorbid depression was found to predict an unfavourable cardiovascular prognosis. However, several studies failed to observe that treatment of depression positively influences cardiac risk. Therefore, focus of research has shifted to identification of subjects, who would benefit from antidepressant therapy that is tailored to their individual needs.Method:Search of literature databases, focusing latest goals and advances in diagnosis and therapy of depression in subjects with cardiovascular disease.Results and discussion:Screening cardiac patients for depression seems to result in a different population of depressed patients, as compared with most trials testing antidepressant agents. This different inclusion process obviously favoured oversampling of subjects with minor or reversible depressive syndromes such as adjustment disorders. It is known that in these conditions placebo treatment is powerful, sometimes equalling verum condition in effectiveness.This hypothesis is supported by re-analysis of former studies revealing selective serotonin reuptake inhibitors (SSRI) to be more effective in subjects with severe or recurrent depression or in patients, in whom depression had begun prior to the onset of cardiovascular disease (e.g., myocardial infarction). Surprisingly, some data support the notion that treatment with SSRIs ameliorates cardiac prognosis irrespective of their antidepressant action. Ongoing studies deal with treatment of depression in patients with heart failure or stroke, and with psychotherapy aimed at reducing cardiac risk factors.

Dopamine transporter binding in depressed patients with anhedonia

Central dopaminergic dysfunction has been widely proposed as a common neurobiological correlate of the psychopathological expression of anhedonia. The dopamine transporter (DAT) is a predominantly presynaptic receptor that may play a critical role in the pathophysiology of dopaminergic transmission. The aim of our study was to evaluate DAT binding in a population of depressed patients with anhedonia. Single photon emission computed tomography (SPECT) with the radiotracer DATSCAN was used to evaluate DAT binding in 11 depressed patients with anhedonia and 9 healthy comparison subjects. Compared with healthy subjects, patients showed significantly lower DAT binding. No significant correlation was found between DAT binding ratios and scores on administered psychometric tests. These findings suggest an alteration in DAT density in depressed patients with anhedonia that may be a primary susceptibility factor or a secondary phenomenon to reduced dopamine concentration in the synaptic cleft.